President Donald Trump's administration is expanding a Medicaid initiative developed during the Biden administration that allows states to provide certain health care services to incarcerated people shortly before they are released. The Centers for Medicare & Medicaid Services approved new Section 1115 reentry demonstrations for Louisiana, Minnesota, Maine and Nevada, while renewing Washington, D.C.'s, broader Medicaid demonstration and giving the district authority to cover certain prerelease services. The approvals took effect October 1 and run through September 30, 2031.
Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, said the decision to approve the reentry programs “reflects a growing understanding that individuals leaving incarceration often face serious barriers to healthcare.” “For participating states, these programs could provide greater federal financial support for connecting eligible individuals with healthcare services before their release, potentially reducing long-term costs to taxpayers and improving public safety,” Beene told Newsweek. The move is a continuation of a policy developed under former President Joe Biden. In April 2023, CMS issued guidance encouraging states to seek Section 1115 demonstration authority to provide targeted Medicaid services before eligible incarcerated people return to their communities.
However, the policy also has roots that predate Biden. The 2018 SUPPORT Act, signed during Trump's first term, directed CMS to issue guidance on how Medicaid waivers could improve health care transitions for people leaving incarceration. Medicaid historically has generally been unable to pay for health services provided to people while they are incarcerated, apart from limited qualifying inpatient care.
For people with mental health or substance-use disorders, this could be especially important. Under Biden, CMS released guidance in April 2023 establishing the Medicaid Reentry Section 1115 demonstration opportunity. States could seek federal approval to use Medicaid for certain services for eligible incarcerated people in the period shortly before their expected release.
Health policy research firm KFF said the minimum benefits contemplated by the Biden-era guidance included case management, medication-assisted treatment for substance-use disorders alongside counseling, and a 30-day supply of prescription medication at release. States could seek coverage for additional services, and prerelease coverage could generally extend from 30 to 90 days before an individual's expected release. Now, Trump's CMS has approved additional states to participate.
The idea has roots in a 2018 law signed by Trump, expanded through Biden admin guidance in 2023, and is now receiving additional approvals under Trump,” Michael Ryan, a finance expert and the founder of MichaelRyanMoney.com, told Newsweek. Someone leaving prison with diabetes, a serious mental illness or an opioid addiction may need treatment immediately. Waiting until they're back in the community to arrange care creates a dangerous gap.” On September 23, CMS announced approvals for several of the states and also renewed Washington, D.C.'s Whole-Person Care Transformation demonstration, authorizing the district to receive federal Medicaid funding for certain prerelease services.
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